This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Monday, 30 March 2009

Here come the kids. God help us.

Yeah it just gets worse and worse and worse. The photo above pretty much depicts the only new staff members we have had over the last few years.

Once a upon a time there was some dickhead worthless manager with a large salary and too much time on his hands He had a determination to justify his existence and job title. So he came up with a plan to staff the wards in a cost effective way.

It is anything but cost effective. Costly and begging for a million pound lawsuit is a better way to describe this crap.

They actually started hiring ward staff at one point before now. But these people were not nurses or health care assistants (who at least have of a bit of a clue). What we got was something called cadets and trainees. Once upon a time I was bitching about health care assistants. Now I want my experienced health care assistants back.

On paper it looks good. Replace all the leaving HCA's and nurses with cadets and trainees. In some places they are called apprentices. They are on minimum wage and do not get shift differentials to work unsocial hours. The 16 year old kids are on less than minimum wage. They will be an extra set of hands on the wards. They will learn about nursing. The trust can get away with paying them less for a myriad of reasons. They are on less than a healthcare assistant. But it is an extra set of hands on the ward in a nurse's uniform. Hopefully someday they will want to go to nursing school.

The idea is supposed to be that (in the beginning of their career as nhs employees) these kids work along side knowledgeable staff and learn and help out. I am just going to refer to these people (apprentices, cadets, juniors, trainees) as kids since most of them are barely out of high school. They are completely untrained and have no prior experience in healthcare.

Occasionally we get a good one. You know what I mean. The ones who are aiming for medical school and nursing school and want to learn all they can are great. But even so they are still dangerous. This is not their fault. I'll explain why in a minute.

Others have no interest in nursing and just want a paycheck. Macdonalds would be much easier love. Some figure this out after about 2 weeks and leave.

Others cannot even spell their names, have no chance of getting into nursing school BUT think that they are already nurses simply because they have a job on the ward caring for patients.

Their confusion is understandable. First of all, their uniform is identical to a nurse's uniform except for one tiny little detail. They have a dark green stripe on the sleeve. Nurses have a light green stripe. The patients and relatives think that every woman in uniform on a ward caring for patients is a nurse and addresses all of them this way. God, does that piss me off. "Nurse" is my hard earned title. Most staff on the ward are nothing like a nurse and this includes healthcare assistants. Sob. I miss the healthcare assistants. I just want someone who knows what they are doing around. Now I have "kids" instead.

And not one of these "kids" has any idea of just what they are walking into. Not one. This job is a little different than selling ice cream cones like they did last summer.

The first few weeks that these untrained kids with no nursing knowledge and no understanding of consequences came onto the ward they were not supposed to be counted in with the staffing numbers. Instead they were supposed to shadow the existing staff and learn how to do the few things that they are actually allowed to do. They cannot even take observations or do blood sugars at this point. They certainly cannot fill in a fluid balance chart. If they know how to do it they certainly hide it well because they never fucking do it. Ever.

What happened on the very first day we had "the kids" starting on our ward (the very beginning of their orientation period)? That shift we had 2 nurses and 3 health care assistants. When the site manager saw that we had 2 new cadets on for that shift in addition to the 5 of us they immediately floated our 3 health care assistants somewhere else. That left only 2 registered nurses and two purple haired, tattooed brand new cadets.

They do this every fucking time we have someone new start. From the first day on the job when new staff are supposed to be on orientation and supernumerary the staff that is supposed to be training them is floated off the ward to cover extreme short staffing on another ward. They do this to new graduate nurses their first week on the job. They do this when we have student nurses on the wards. They float away some of the regular staff to cover dangerously short other wards because we have an extra set of hands in the form of nursing students. The nursing students spend all day running after call bells and never fucking learn anything.

When yours truly started as a brand new nhs staff nurse, having never worked in an NHS hospital before because I lived with my dad for awhile and trained abroad; I had 2 days being supernumerary and then on the 3rd day I was left in charge of the ward whilst my mentor was sent to cover sickness on the ward downstairs. New nurses should be on a 6 month preceptorship as new nurses. And please, none of this BS about how this is due to academic nurse training not preparing people. That has nothing to do with this.

The university trained nurses are getting plenty of time on the wards as student nurses. PLENTY. It is the quality of that time that is the problem. THE FUCKING QUALITY.

Almost immediately after the kids started we were finding that the experienced staff were outnumbered by the kids on most shifts. But they are still being paid as "apprentices". They were never trained properly to do the few things that they are allowed to do because they were never there in addition to a well staffed ward. If we had 2 staff nurses and 3 kids we were grateful. A fucking supercuts salon has more goddamn trained staff than that. And they only have to deal with one person at a time.

I said earlier that it was the idea that these kids would gain vocational experience and go on to nursing school later. Ha ha ha ha. They see the nurses getting screamed at, blamed for everything, working like dogs 14 hour shifts with no breaks while the kids themselves have multiple tea breaks and hide in the toilets on their mobiles. If I say anything to them management will get real upset with me for upsetting the cheap labour.

None of them want to be nurses anymore. If anything they have been talked out of it. Right now they get to prance around in nurse's uniforms, get addressed as "nurse" by the patients and visitors, all the while taking lots of breaks and not being accountable for any of their actions. They don't have a registration. Everything they do is on my registration. They are happy right where they are.

Our HCA's are becoming a thing of the past. The ones that are leaving are not being replaced by anything except kids. I feel like I am spending 99% of my time babysitting these new dangerous brats. At least the HCA's were goddamn trained to do their goddamn jobs.

That's cruel of me. There are a few of them who work hard and at one time wanted to continue into nursing. Many of them are doing way better than I would have done thrown into a ward like this at age 16.

But it is still a really fucked up situation. And all this time qualified nurses with years of experience who moved into the area are getting told "sorry, no jobs". That hopefully will change now that the Staffordshire story broke. We are holding our breath, desperate for a miracle and some trained staff.

I need to run now but I will do a blog post all about cadet horror stories and explain just how much this situation screws with patient care.

11 comments:

My PC crashed as I wrote "Fuck me. Just when I thought the NHS could not get any worse"...an omen perhaps. Sadly, managers work to a very different agenda whilst insulated in their cosy office away from the real world. A crisis for them is measured in numbers i.e. too many bodies on the shop floor= too much cost. Sadly, too many bodies on the shop floor is the literal cost of understaffing.Many managers now undergo Nero training: fiddling whilst Rome burns.

The ironic thing is, if there's anything that ought to be obvious in this day and age, it's that often the best recruits for nursing are not bright-eyed, bushy-tailed 18 year olds, but more mature applicants who've had their time in the School of Hard Knocks. So why do we need teenagers? We should be recruiting older people who perhaps need a career change now the recession's hit.

If I'd qualified as a mental health nurse when I was 21, with hindsight I don't think I'd have had the life experience or emotional maturity to be good at the job. Fortunately I qualified at 31, and nowadays I do have that maturity.

After reading this post I am just speechless!! Has medical care in the UK really sunk this low?

My wife is an RN here in Sydney with 30+ years experience and from the "old school". Nothing she has ever told me about her hospital even comes close to what I have been reading on this blog & a couple of other medical blogs. I know that our Medicare health system in OZ has it's share of problems but the hospitals here do not have the criminal uderstaffing that you are talking about.

Thankyou for the explanation of the kids. I've only just found your blog but a few days ago I found another blog by a young person who is working in an A&E department somewhere because they want to be either a paramedic or an A&E nurse when they grow up. I don't know how long they've been there or how good they really are - but, by God, they have a fantastic opinion of their own abilities. Our beloved government tells me I don't care which doctor I see, any one will do. Er - I do. I'm fed up with having to explain my medical history to another new person when I do have some control over which GP I see. So now they're telling me I don't care who looks after me in hospital are they. Er - I do. I'd like it to be someone who knows what they are doing. I'm not allowed to do anything with the electrics in my home - so why should that sort of thinking not apply to my medical home? Thank goodness my NHS-employed husband has finally got to 3 months and counting to (very) early retirement so he can do the medical research that is his life-blood. But my heart bleeds for the daughter who is a similar position to you (in charge of 15 very sick respiratory patients less than 6 months after qualifying), who loves the work but is never finished on time to get home to the husband who is in the Ambo service and the 2 kids. And for the daughter who is training as a paramedic, luckily at least in a Trust that still trains its own so she is in a better situation (I believe) than the ones who go to Uni and then get a job.Love the blog - I swear a lot more now than I used to, as well. Something to do with the NHS I think. If people don't like it - well. they can do the other. I think you are actually quite restrained under the circumstances.

Dear ZarathustraI commenced nursing as an older student and I was shocked to be spoken to as though I was a recalcitrant teenager. It was totally unneccesary. As a middle-aged person, I certainly would never allow my family to belittle me in this way so why should I have to tolerate being spoken to rudely by employees of the NHS? Thankfully I possessed a healthy self-respect and so high-tailed it out of there. Sure I had had my time in the School of Hard Knocks and it wasn't all sweetness and light but never did I experience the level of discourtesy I encountered within the NHS. Why is humiliating trainees an accepted part of the training, almost like a rite of passage? Why treat mature adults in this way? It is a crazy way of carrying on. I would certainly not recommend nursing as a mid-life career change, not if you want to keep your hard-earned dignity and self-esteem.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.